Spleen-preserving pancreatectomy with removal of splenic vessels: impact on splenic parenchyma ?

BACKGROUND: While outcomes after spleen-preserving distal pancreatectomy (SP-DP) have been widely reported, impacts on splenic parenchyma have not been well studied. This study aimed to compare postoperative outcomes, particularly spleen-related outcomes, by assessing splenic imaging after SP-DP with or without splenic vessels removal. METHODS: Data for all patients who underwent SP-DP with splenic vessels removal (Warshaw technique, WDP) or preservation (Kimura technique, KDP) between 2010 and 2022 in two tertiary centres were retrospectively analysed. Splenic ischemia and volume at early/late imaging and postoperative outcomes were reviewed. RESULTS: Eighty-seven patients were included, 51 in the WDP and 36 in the KDP groups. Median Charlson's Comorbidity Index was significantly higher in the WDP group compared with the KDP group. Postoperative morbidity was similar between groups. There was more splenic ischemia at early imaging in the WDP group compared to the KDP group (55% vs. 14%, p = 0.018), especially severe ischemia (23% vs. 0%). Partial splenic atrophy was observed in 29% and 0% in the WDP and KDP groups, respectively (p = 0.002); no complete splenic atrophy was observed. Platelet levels at POD 1, 2 and 6 were significantly higher in the WDP group compared to KDP group. At univariate analysis, age, Charlson Comorbidity Index, platelet levels at POD 6, and early splenic infarction were prognostic factors for development of splenic atrophy. No episodes of overwhelming post-splenectomy infection or secondary splenectomy were recorded after a median follow-up of 9 and 11 months in the WDP and KDP groups, respectively. CONCLUSIONS: Splenic ischemia appeared in one-half of patients undergoing SP-DP with splenic vessels removal at early imaging, and partial splenic atrophy in almost 30% at late imaging, without clinical impact or complete splenic atrophy. Age, Charlson Comorbidity Index, platelet levels at POD 6, and early splenic infarction could help to predict the occurrence of splenic atrophy.

Invasive Assessment of Coronary Microcirculation: A State-of-the-Art Review.

A significant proportion of patients presenting with signs and symptoms of myocardial ischemia have no "significant" epicardial disease; thereby, the assessment of coronary microcirculation gained an important role in improving diagnosis and guiding therapy. In fact, coronary microvascular dysfunction (CMD) could be found in a large proportion of these patients, supporting both symptoms and signs of myocardial ischemia. However, CMD represents a diagnostic challenge for two main reasons: (1) the small dimension of the coronary microvasculature prevents direct angiographic visualization, and (2) despite the availability of specific diagnostic tools, they remain invasive and underused in the current clinical practice. For these reasons, CMD remains underdiagnosed, and most of the patients remain with no specific treatment and quality-of-life-limiting symptoms. Of note, recent evidence suggests that a "full physiology" approach for the assessment of the whole coronary vasculature may offer a significant benefit in terms of symptom improvement among patients presenting with ischemia and non-obstructive coronary artery disease. We analyze the pathophysiology of coronary microvascular dysfunction, providing the readers with a guide for the invasive assessment of coronary microcirculation, together with the available evidence supporting its use in clinical practice.

Bases psicosociales del prejuicio étnico en el Perú: el caso de las categorías afroperuanos, peruanos andinos y peruanos blancos / Psychosocial bases of ethnic prejudice in Peru: the case of Afro-Peruvian, Andean-Peruvian and White Peruvians categories

Tomando como base una muestra de personas de clase media de la ciudad de Lima (n=194) se analiza la relación entre variables ideológicas, emocionales y de contenido estereotípico con la valoración personal y percibida de tres categorías étnico raciales: peruanos andinos, peruanos blancos y afroperuanos. Los resultados permiten visibilizar el papel de las variables ideológicas en los niveles de prejuicio dirigidos a dichas categorías, principalmente a las categorías blanco y afroperuano. Además, se hallaron impactos específicos de dimensiones estereotípicas tradicionalmente asociadas con la categoría blanco, andino y afroperuano, como la competencia, lo moral y lo positivo en términos de calidez, respectivamente. Así también, se identifican impactos específicos de las emociones asociadas a cada categoría, principalmente a la categoría peruano blanco y peruano andino. Se analizan además las diferencias obtenidas en los niveles de conservadurismo por sexo. Finalmente, se discute lo hallado a la luz de la evidencia sistemática hallada en otras investigaciones en contextos nacionales.

Based on a sample of middle-class people from the city of Lima (n = 194), the relationship between ideological, emotional and stereotypical content variables is analyzed with the personal and perceived value of three ethnic-racial categories: Andean Peruvians, White Peruvians, and Afro-Peruvians. The results allow visualizing the role of ideological variables in the levels of prejudice directed to these categories, mainly to the White and Afro-Peruvian categories. Moreover, specific impacts of stereotypical dimensions traditionally associated with White, Andean and Afro-Peruvian categories were found, such as competition, moral and the positive in terms of warmth, respectively. Additionally, specific impacts of the emotions associated with each category are identified, mainly to the White and Andean-Peruvian. Furthermore, the differences obtained in the levels of conservatism by sex are also analyzed. Finally, findings are discussed in the light of the systematic evidence found in other investigations in national contexts.

Parenteral nutrition-associated cholestasis and triglyceridemia in surgical term and near-term neonates: A pilot randomized controlled trial of two mixed intravenous lipid emulsions.

BACKGROUND: Cholestasis is a common complication in infants receiving prolonged parenteral nutrition (PN). We studied the effects of two intravenous lipid emulsions composed with either 30% soybean oil, 30% medium-chain triglycerides (MCT), 25% olive oil, and 15% fish oil (SMOF) or with 50% MCT and 50% soybean oil n-6 (MCT/SOY) on the incidence of cholestasis in surgical term and near-term neonates. METHODS: A single-center, double-blinded, randomized controlled trial compared the incidence of cholestasis using either SMOF or MCT/SOY in neonates born at gestational age ≥34 weeks undergoing major surgery. The primary outcome was the incidence of conjugated serum bilirubin >1 mg/dL. Other liver enzymes were assessed as secondary outcomes. A post-hoc analysis assessed serum triglycerides levels. Odds ratios were estimated by mixed-effects regression models. RESULTS: Enrollment was prematurely interrupted because the MCT/SOY became unavailable, thus 49 infants (SMOF 22, MCT/SOY 27) completed the study. The exposure (time on PN, cumulative dose of lipids) was similar in both groups. Similar cumulative incidence rates were found for elevated conjugated bilirubinemia and other liver enzymes. Hypertriglyceridemia >250 mg/dL (12/49) was more frequent in MCT/SOY (37.0%, 95% CI 21.53-55.77) than in SMOF (9.1%, 95% CI 2.53-27.81, p = 0.024). Triglyceridemia at the first assessment (median 8 postnatal days) was significantly higher with MCT/SOY than with SMOF (181 vs. 134 mg/dL, p = 0.006). Over the whole study period, mean triglyceride concentration was 36.5 mg/dL higher with MCT/SOY compared with SMOF (p = 0.013). CONCLUSION: Both emulsions had similar effects on the incidence of cholestasis and markers of liver integrity, but MCT/SOY induced higher serum triglyceride concentrations. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02633384.

Psicología política del conflicto: relaciones intergrupales, exclusión social y participación política no convencional en el Perú / Political psychology of conflict: intergroup relations, social exclusion and unconventional political participation in Peru / Psicologia política do conflito: relações intergrupais, exclusão social e participação política não convencional no Peru / Psychologie politique des conflits: les relations intergroupes, l'exclusion sociale et la participation politique non conventionnelle au Pérou

El presente artículo tiene por objetivo analizar la naturaleza de las relaciones intergrupales en el Perú y a partir de esta reflexión establecer algunos puntos a tener en cuenta respecto a las raíces de la exclusión y el conflicto social, dadas las relaciones jerárquicas entre distintos grupos que diversos estudios exploratorios han ido revelando durante los últimos años (Espinosa, 2006; Espinosa & Pancorbo, 2009; Espinosa, Cueto & Schmitz, 2012; Espinosa & Cueto, 2014). Por otro lado, se plantea cómo los mecanismos de participación política no convencional vienen siendo legitimados por los grupos sociales excluidos, dada la poca legitimidad con la que se percibe al Estado y las herramientas formales de participación (Córdova, 2013). Finalmente, revisaremos las principales secuelas psicosociales del Conflicto Armado Interno (CAI) (Guillén, 2013) y sus relaciones con los conflictos socioambientales en la actualidad, así como las nuevas formas de conflicto intergrupal evidenciadas a través de las redes sociales, principalmente en contextos electorales (Guevara, 2012).(AU)

The aim of this article is to analyze intergroup relations nature in Peru and from this reflection set some points to consider regarding the roots of exclusion and social conflict, given by hierarchical relationships between different groups that some exploratory studies have been revealing in recent years (Espinosa, 2006; Bucksport & Espinosa, 2009; Espinosa, Cueto & Schmitz, 2012; Espinosa & Cueto, 2014). Furthermore, it presents how unconventional mechanisms of political participation are being legitimized by social excluded groups, due to the lack of legitimacy that the state is perceived and formal participation tools (Cordova, 2013). Finally, the major psychosocial sequelae of Internal Armed Conflict (IAC) are reviewed (Guillén, 2013) and their relation with socio-environmental conflicts today, as well as new forms of intergroup conflict evidenced through social networks, especially in electoral contexts (Guevara, 2012).(AU)

Este artigo tem como objetivo analisar a natureza das relações intergrupais no Peru e deste reflexo definir alguns pontos a considerar sobre as raízes da exclusão e conflito social, dadas as relações hierárquicas entre diferentes grupos divulgadas em vários estudos nos últimos anos (Espinosa, 2006; Bucksport & Espinosa, 2009; Espinosa, Cueto & Schmitz, 2012; Espinosa & Cueto, 2014). Por outro lado, considera como os mecanismos de participação política não convencional estão sendo legitimada por grupos sociais excluídos, dada a pouca legitimidade com que percebe as ferramentas de participação formais do Estado (Cordova, 2013). Finalmente, vamos analisar as principais sequelas psicossociais do conflito armado interno (CAI) (Guillén, 2013) e suas relações com conflitos ambientais atuais, bem como novas formas de conflito intergrupal evidenciado através das redes sociais, especialmente em contextos eleitorais (Guevara, 2012).(AU)

Cet article vise à analyser la nature des relations intergroupes au Pérou et de cette réflexion définir quelques points à considérer en ce qui concerne les racines de l'exclusion et les conflits sociaux, données les relations hiérarchiques entre les différent groupes des diverses études exploratoires ont été révélés au cours des dernières années (Espinosa, 2006 ; Espinosa et Bucksport, 2009 ; Espinosa, Cueto et Schmitz, 2012 ; Espinosa et Cueto, 2014). D'un autre côté, on projette comment les mécanismes de participation politique non conventionnelle sontlégitimés par des groupes sociaux exclus, donnée la faible légitimité dont il perçoit l'État et outils formels de participation (Cordoue, 2013). Enfin, nous réviserons les principales psycho-sociales séquelles du Conflit Armé Interne (CAI) (Guillén, 2013) et leurs relations avec les conflits socio-environnementaux actuellement, ainsi que les nouvelles formes de conflit intergroupal mises en évidence à travers les réseaux sociaux, surtout dans le contexte des élections (Guevara, 2012).(AU)

Psicología política del conflicto: relaciones intergrupales, exclusión social y participación política no convencional en el Perú / Political psychology of conflict: intergroup relations, social exclusion and unconventional political participation in Peru / Psicologia política do conflito: relações intergrupais, exclusão social e participação política não convencional no Peru / Psychologie politique des conflits: les relations intergroupes, l'exclusion sociale et la participation politique non conventionnelle au Pérou

El presente artículo tiene por objetivo analizar la naturaleza de las relaciones intergrupales en el Perú y a partir de esta reflexión establecer algunos puntos a tener en cuenta respecto a las raíces de la exclusión y el conflicto social, dadas las relaciones jerárquicas entre distintos grupos que diversos estudios exploratorios han ido revelando durante los últimos años (Espinosa, 2006; Espinosa & Pancorbo, 2009; Espinosa, Cueto & Schmitz, 2012; Espinosa & Cueto, 2014). Por otro lado, se plantea cómo los mecanismos de participación política no convencional vienen siendo legitimados por los grupos sociales excluidos, dada la poca legitimidad con la que se percibe al Estado y las herramientas formales de participación (Córdova, 2013). Finalmente, revisaremos las principales secuelas psicosociales del Conflicto Armado Interno (CAI) (Guillén, 2013) y sus relaciones con los conflictos socioambientales en la actualidad, así como las nuevas formas de conflicto intergrupal evidenciadas a través de las redes sociales, principalmente en contextos electorales (Guevara, 2012)...

The aim of this article is to analyze intergroup relations nature in Peru and from this reflection set some points to consider regarding the roots of exclusion and social conflict, given by hierarchical relationships between different groups that some exploratory studies have been revealing in recent years (Espinosa, 2006; Bucksport & Espinosa, 2009; Espinosa, Cueto & Schmitz, 2012; Espinosa & Cueto, 2014). Furthermore, it presents how unconventional mechanisms of political participation are being legitimized by social excluded groups, due to the lack of legitimacy that the state is perceived and formal participation tools (Cordova, 2013). Finally, the major psychosocial sequelae of Internal Armed Conflict (IAC) are reviewed (Guillén, 2013) and their relation with socio-environmental conflicts today, as well as new forms of intergroup conflict evidenced through social networks, especially in electoral contexts (Guevara, 2012)...

Este artigo tem como objetivo analisar a natureza das relações intergrupais no Peru e deste reflexo definir alguns pontos a considerar sobre as raízes da exclusão e conflito social, dadas as relações hierárquicas entre diferentes grupos divulgadas em vários estudos nos últimos anos (Espinosa, 2006; Bucksport & Espinosa, 2009; Espinosa, Cueto & Schmitz, 2012; Espinosa & Cueto, 2014). Por outro lado, considera como os mecanismos de participação política não convencional estão sendo legitimada por grupos sociais excluídos, dada a pouca legitimidade com que percebe as ferramentas de participação formais do Estado (Cordova, 2013). Finalmente, vamos analisar as principais sequelas psicossociais do conflito armado interno (CAI) (Guillén, 2013) e suas relações com conflitos ambientais atuais, bem como novas formas de conflito intergrupal evidenciado através das redes sociais, especialmente em contextos eleitorais (Guevara, 2012)...

Cet article vise à analyser la nature des relations intergroupes au Pérou et de cette réflexion définir quelques points à considérer en ce qui concerne les racines de l'exclusion et les conflits sociaux, données les relations hiérarchiques entre les différent groupes des diverses études exploratoires ont été révélés au cours des dernières années (Espinosa, 2006 ; Espinosa et Bucksport, 2009 ; Espinosa, Cueto et Schmitz, 2012 ; Espinosa et Cueto, 2014). D'un autre côté, on projette comment les mécanismes de participation politique non conventionnelle sontlégitimés par des groupes sociaux exclus, donnée la faible légitimité dont il perçoit l'État et outils formels de participation (Cordoue, 2013). Enfin, nous réviserons les principales psycho-sociales séquelles du Conflit Armé Interne (CAI) (Guillén, 2013) et leurs relations avec les conflits socio-environnementaux actuellement, ainsi que les nouvelles formes de conflit intergroupal mises en évidence à travers les réseaux sociaux, surtout dans le contexte des élections (Guevara, 2012)...

Estudo da prevalência de insuficiência cardíaca em indivíduos cadastrados noprograma médico de família - Niterói. Estudo Digitalis: desenho e método / Heart failure prevalence study among patients enrolled in the family health program, Niterói. The DIGITALIS Study: design and method

Fundamentos: A insuficiência cardíaca (IC) representa um importante problema de saúde pública, tem custoelevado e crescente prevalência nos países desenvolvidos e em desenvolvimento. Dados do Sistema Único de Saúde, que responde por 80% do atendimento médico da população brasileira, mostram que as doenças cardiovasculares são a terceira causade internação, sendo a IC a causa mais frequente entre as doenças cardiovasculares após os 60 anos. Pesquisas sobre epidemiologia envolvendo prevalência da ICsão escassos no Brasil principalmente na atenção primária. Objetivo: Estimar a prevalência da insuficiência cardíaca na atenção primária. Métodos: Estudo observacional, transversal, envolvendo 632 indivíduos selecionados de modoaleatório, com idade ≥45 anos, assistidos pelo Programa Médico de família de Niterói, RJ. O diagnóstico de IC será confirmado ou excluídoutilizando-se: exame clínico, eletrocardiograma, ecocardiograma e dosagem de BNP. Todos os pacientesserão classificados em estágios que avaliam a progressão fisiopatológica da IC, de acordo com o estabelecido na III Diretriz Brasileira de IC crônica.Conclusão: O estudo pretende estabelecer a prevalência de IC em uma comunidade urbana, o que irá ajudarno planejamento da política de saúde para o cuidado da IC.

Heart failure with preserved ejection fraction and systolic dysfunction in the community.

BACKGROUND: In developed countries, heart failure with preserved ejection fraction (HFpEF) is more prevalent than heart failure with reduced ejection fraction (HFrEF) in the community. However, it has not been completely established if this fact is also observed within our community. OBJECTIVE: To determine the most prevalent form of heart failure (HFpEF or HFrEF) and whether the prevalence of HFpEF is higher in the community. METHODS: This is a cross-sectional study conducted with patients clinically diagnosed with HF who were seen in community-based health care centers from January to December 2005. Echodopplercardiograms were performed for all patients. The form of HF was stratified according to the presence of abnormalities and the shortening fraction observed on the echodopplercardiogram. RESULTS: The study evaluated 170 patients (61.0 +/- 13.3 years of age), most of them women and elderly. HFpEF was the more prevalent form of HF (64.2%, p<0.001), affecting mostly elderly women (62%, p = 0.07), whereas the opposite condition, HFrEF, was observed mostly in elderly men (63.6%, p = 0.07). Patients with no HF represented one-third of the cases (27.6%). HFrEF patients had more lower-limb edema, coronary disease, diabetes, chronic renal failure, higher Boston scores and hospital readmissions. Use of alcoholic beverages and smoking were also more common among HFrEF patients. CONCLUSION: HFpEF is the most prevalent form of HF in the community especially among elderly women, whereas HFrEF affects mostly elderly men and is associated with greater clinical severity, main risk factors and no changes in lifestyle. Despite the signs and symptoms of HF, this condition was not confirmed for one-third of the cases.

Insuficiência cardíaca com fração de ejeção preservada e com disfunção sistólica na comunidade / Heart failure with preserved ejection fraction and systolic dysfunction in the community

FUNDAMENTO: Em países desenvolvidos, a insuficiência cardíaca com fração de ejeção preservada (ICFEP) é o modelo mais prevalente que a insuficiência cardíaca com disfunção sistólica (ICDS) na comunidade. No entanto, não está plenamente estabelecido se tal fato também é observado na nossa comunidade. OBJETIVO: Determinar o tipo mais prevalente de insuficiência cardíaca (ICFEP ou ICDS) e se a prevalência de ICFEP é elevada na comunidade. MÉTODOS: Estudo transversal de pacientes atendidos na comunidade com diagnóstico clínico de IC, de janeiro a dezembro de 2005. O ecodopplercardiograma foi realizado em todos os pacientes. O tipo de IC foi estratificado pela presença de anormalidades e pela fração de encurtamento ao ecodopplercardiograma. RESULTADOS: O estudo avaliou 170 pacientes (61,0±13,3 anos), a maioria mulheres e idosos. A ICFEP foi o tipo de IC mais prevalente (64,2 por cento, p<0,001) com tendência nas mulheres idosas (62 por cento, p=0,07), e o inverso na ICDS, nos homens idosos (63,6 por cento, p=0,07). Os pacientes sem IC representaram um terço dos casos (27,6 por cento). A ICDS apresentou mais edema de membros inferiores, doença coronariana, diabete, insuficiência renal crônica, re-internações e maior escore de Boston. O etilismo e o tabagismo estiveram mais presentes na ICDS. CONCLUSÃO: A ICFEP é o tipo de IC mais prevalente na comunidade, principalmente nas mulheres idosas, enquanto a ICDS, nos homens idosos, com maior gravidade clínica e acometimento dos principais fatores de risco e sem modificação nos hábitos de vida. Apesar dos sinais e dos sintomas de IC, em um terço dos casos a IC não foi confirmada.

BACKGROUND: In developed countries, heart failure with preserved ejection fraction (HFpEF) is more prevalent than heart failure with reduced ejection fraction (HFrEF) in the community. However, it has not been completely established if this fact is also observed within our community. OBJECTIVE: To determine the most prevalent form of heart failure (HFpEF or HFrEF) and whether the prevalence of HFpEF is higher in the community. METHODS: This is a cross-sectional study conducted with patients clinically diagnosed with HF who were seen in community-based health care centers from January to December 2005. Echodopplercardiograms were performed for all patients. The form of HF was stratified according to the presence of abnormalities and the shortening fraction observed on the echodopplercardiogram. RESULTS: The study evaluated 170 patients (61.0 ± 13.3 years of age), most of them women and elderly. HFpEF was the more prevalent form of HF (64.2 percent, p<0.001), affecting mostly elderly women (62 percent, p = 0.07), whereas the opposite condition, HFrEF, was observed mostly in elderly men (63.6 percent, p = 0.07). Patients with no HF represented one-third of the cases (27.6 percent). HFrEF patients had more lower-limb edema, coronary disease, diabetes, chronic renal failure, higher Boston scores and hospital readmissions. Use of alcoholic beverages and smoking were also more common among HFrEF patients. CONCLUSION: HFpEF is the most prevalent form of HF in the community especially among elderly women, whereas HFrEF affects mostly elderly men and is associated with greater clinical severity, main risk factors and no changes in lifestyle. Despite the signs and symptoms of HF, this condition was not confirmed for one-third of the cases.